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Why is kidney donation on the decline?

United Network for Organ Sharing (UNOS) is the non-profit, scientific and educational organization that administers the nation's only Organ Procurement and Transplantation Network (OPTN), established by the U.S. Congress in 1984. UNOS/OPTN collect and publish data on the number of transplants performed, by organ and donor types, as well as wait list data.

UNOS data shows that kidney donation has declined each of the last 3 years, down from a peak in 2006. At the same time, need is increasing as evidenced by waiting list data.

Why do you think that donation is on the decline?

Posted: 1/21/2010 3:13 p.m. by Arthur Matas, M.D.

Comments:

The comments have been important.  The United Network for Organ Sharing (UNOS) data (www.UNOS.org) shows a decrease in organ donation in the last couple of years.  I agree that we should eliminate disincentives to living donation (lost wages, child care costs, etc).  And it is my personal belief that we should do trials to determine whether or not incentives to donors would increase living donation.  But the law would have to be changed before such trials could be done.  So far there has not been an organized effort to make these changes.  The greatest impact would come from potential and past donors and recipients.

Posted: 1/28/2010 9:16 p.m. by Arthur Matas, M.D.

 First let me say I am an altruistic donor so I have experientially earned the right to say what I am about to say. Right now it's ILLEGAL to reimburse a donor's non-medical expenses such as travel, time off work and increased health insurance costs. Why? They say it amounts to buying/selling organs. Poppycock. If potential donors didn't have to bear such a high percentage of the cost of donating personally, more would be thrilled to be ABLE to do it, fewer people would have to sit around on dialysis, and we'd save kidney care expense overall. So in my mind, the present organ collection system mandates an inflexible and unethical DISincentive to donate organs. So I very much hope that this lopsided approach will change. I am not aware of any organization that is lobbying for this at a federal level but I would certainly be intersted in hearing about such a thing!

Posted: 1/28/2010 1:38 p.m. by Rachel

Great discussion!

We would contend that organ donations aren't necessarily declining, but are actually relatively constant.

What's happening is there is more need for organs, so it looks like there are less organs/transplants.

The organ donation "flat line" is more for deceased kidney donation. Again, we have the same percent of people signing up each year. However, when you compare that to the growing need, it looks like it is declining.

The big opportunity will be with living donation. However, it takes awareness and understanding to have more people get involved.

Posted: 1/24/2010 12:33 p.m. by PKD Foundation

I've wondered myself, having noticied a drop off in all forms of living donation from a peak of 7,004 in 2004. A small portion can be traced to a decline in "other" forms of living donation like liver and lung, perhaps because of increased scrutiny of these programs following living liver donor deaths. I'm not sure what's behind the decline in kidney donors. I have a note into a psychosocial researcher to see if she's run across a change in attitudes from potential donors. Great question... worthy of more investigation.

Posted: 1/24/2010 7:28 a.m. by Michael, Living Donors Online

I think that it can be argued the problem is multifaceted:

A) The public doesn't realize the need; other people's problems tend to get lost in a sea of our own as everyone feels economic disturbances, social ills and the like.

Lets be honest we are living through a very interesting time of American History right now, and no one is sure how its all going to wind up.  Hence it's easy to forget about things like Kidney disease if its not affecting their own life directly.

B) Most people don't know the relative ease of being a living donor, Yeah it's a hassle and it has a recovery period. But it doesn't have a long-term effect on the donor but has profound impact on the recipient.

C) Inspiration, there aren't a lot of role models for potential donors to follow. When the most famous kidney donor you can think of is Homer Simpson, well then its safe to assume that live donorship has a slight image problem.

D) Economics is a big part, not only is there not an incentive for them to donate, but in a way there is a penalty as they usually have to give up vacation time, if not taking time off outright that they are not reimbursed for. Something that is very hard to do in these times of economic strife.

Its really the job of kidney community to dispel myths, raise awareness with the public and lobby with state and federal government to help remedy the economic woes associated with donation. If we can do that it’s reasonable we can help to end the wait.

Posted: 1/23/2010 3:34 p.m. by Chris Strouth (recent kidney recipient)

Is that the right question?

To me, the discrepancy between annual Kidney transplants and the total number of waiting/dying patients on UNOS' list is what's so disheartening.

We need to move the discussion about financial incentives from theoretical speculations into the political arena and create some laws that allow us to do just that: a new way to reduce the crippling organ shortage!  

Posted: 1/22/2010 9:36 p.m. by Renal Ranger

I am concerned that the poor economy has caused potential donors to reconsider the impact of being out of work for several weeeks after donating a kidney.

Posted: 1/22/2010 9:03 p.m. by Barry Friedman, R.N.

Not sure.Perhaps the moral divide is widening between those with charitable tendencies vs. narcisism. Whatever the decline, we are seeing many altruistic donors coming our way. 1300+ are registered in our system to date and that is something we continue to be humbled by. Kind Regards Joe

Posted: 1/22/2010 5:57 p.m. by NationalKidneyRegistry